Abstract
Objectives Post-cesarean section scar diverticulum (PCSD) is a long-term sequela of cesarean section (CS). The aim of this study was to evaluate the clinical utility of PCSD scoring criteria, and also retrospectively investigate the efficacy and fertility of two different surgical methods in 304 patients with PCSD. Methods A total of 304 PCSD patients who underwent hysteroscopy or combined hysteroscopy and laparoscopy (referred to as laparoscopy) in our hospital from 2016 to 2018 were retrospectively analyzed. Preoperative condition was analyzed by the PCSD scoring criteria and its influencing factors were explored. The efficacy, its influencing factors and pregnancy success rate of the two different surgical methods on PCSD was also analyzed after 6- and 12-months follow-up. Results PCSD was more severe (high score) in patients who experienced caesarean section with one of the following conditions: age>30 years old, without medical indications or retroflexed uterus. The postoperative efficacy of patients subjected to hysteroscopy or laparoscopy was 81.25 and 89.47% (after 6 months), and 79.53 and 87.50% (after 12months), respectively. Hysteroscopic surgery was better for PCSD patients who had fewer CS and thicker residual muscle layer and worse for PCSD patients with a longer distance of incision defect to the end of the cervix. Postoperative fertilization showed that pregnancy success rate of patients subjected to hysteroscopy or laparoscopy was 56.2 and 50%, respectively. Conclusions The PCSD scoring is an effective method for assessing the severity of PCSD, and hysteroscopy and laparoscopy are effective modalities for PCSD. Hysteroscopy is also an option for patients with fertility needs.
Highlights
Post-cesarean section scar diverticulum (PCSD) is a longterm complication after cesarean section (CS)
The harm that PCSD brings to women has received increasing public attention [13, 14]
The mechanism behind the development of PCSD is still unclear, it is believed that acquired diverticulum is mainly caused by poor wound healing after cesarean section, with an incidence of 4–9% [15]
Summary
Post-cesarean section scar diverticulum (PCSD) is a longterm complication after cesarean section (CS). Because the incision after CS healed poorly, a diverticulum connecting to the uterine cavity is formed with the scar tissue at the lower end of the diverticulum, blocking the outflow of menstrual blood. The menstrual blood accumulates in the diverticulum and is delivered after menstruation, gradually leading to clinical manifestations of abnormal uterine bleeding (AUB), dysmenorrhea, secondary infertility and so on [1]. The number of CS has been rising globally [2,3,4,5]. With the full liberalization of the national second-child policy, the vast majority of women with scared uterus still choose CS when they are pregnant again, thereby significantly increasing the number of CS and the incidence of PCSD. The diagnosis and treatment of PCSD have gradually received extensive attention
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